End User and Primary Care Physicians' Perspectives on Digital Innovations in Dementia Risk Detection: Focus on a Digital Sleep Biomarker.

backgroundDementia is a global health priority. Early identification in asymptomatic or mildly symptomatic individuals (ie, dementia risk detection) is proposed as a clinical solution for early intervention and could support researchers to identify novel neuropathological targets and recruit to clinical trials. Digital biomarkers of behavioral or physiological markers, including sleep, are cited as a potential low-cost, noninvasive, and objective method for dementia risk detection. Understanding perspectives on digital biomarkers, particularly acceptability, from potential end users and clinical staff is required when considering implementation within any clinical service. With emerging evidence of sleep as a risk marker for dementia, the efficacy of the Dementia Research Institute Sleep Index (DRI-SI), based on continuous remote monitoring of sleep patterns detected by a digital sleep mat, for dementia risk detection, is currently being explored by the InSleep46 study.

objectiveThis qualitative substudy aimed to explore perspectives of potential end users and primary care physicians regarding the use of a digital sleep mat to measure the DRI-SI and its application towards dementia risk detection.

methodsThirty-one potential end users (age: 31-82 years, 11 female and 20 male) from Newcastle and London, United Kingdom, with personal or caregiving experience related to dementia, participated in qualitative focus group workshops. They shared opinions on integrating the sleep mat into their homes, the DRI-SI's potential for identifying dementia risk, and the necessary information for engagement with related clinical services. Seven primary care physicians from across England participated in semistructured interviews regarding the potential application of the DRI-SI in dementia risk detection and its integration into current clinical practice. Inductive thematic analysis was conducted to identify key themes.

resultsFour key themes emerged from end user focus groups: (1) practical use, (2) prospective acceptability, (3) clinical management, and (4) data concerns. Three main themes came from the semistructured interviews with physicians: (1) prospective acceptability, (2) health care provision, and (3) practical considerations. Common themes were identified in both groups but held differing perspectives. End users were focused on practical aspects of integrating the digital sleep mat within their daily life, the effect of the DRI-SI on clinical care, and privacy concerns regarding data use. Primary care physicians were concerned more broadly with how the DRI-SI and dementia risk detection service would integrate into current clinical practice, the impact on clinical resources and patient well-being, and the need for clinical actionability and guidance on discussing results with patients.

conclusionsEnd users would find the DRI-SI acceptable as part of their clinical care, but primary care physicians require a more robust evidence base. Future research should explore the integration of the DRI-SI into clinical care/research pathways to enhance clinical acceptability. Five key recommendations have been made for further development of digital biomarkers for dementia risk populations.